Endophthalmitis More Common After Intravitreal Injection Than Intraocular Surgery

Streptococcal isolates are approximately 3 times more frequent after anti-VEGF intravitreal injections than after intraocular surgery, according to the results of a meta-analysis presented by Colin A. McCannel, MD, at the Retina Subspecialty Day in Orlando, Florida. The meta-analysis, conducted by Dr. McCannel, was published earlier this year in Retina.[1]

The meta-analysis included US literature from 2005 to 2009 that reported endophthalmitis after intravitreal injection of anti-VEGF agents; the results of this analysis was compared with reports of endophthalmitis bacterial isolates after intraocular surgery in the United States.

Among 105,536 injections, there were 52 cases of endophthalmitis, Dr. McCannel reported. Of those cases, 24 were culture negative and 26 had culture-positive organisms, 8 of which were of the Streptococcus species. In the Endophthalmitis Vitrectomy Study, Streptococcus species were significantly more frequent after intravitreal injection that after intraocular surgery, Dr. McCannel said.

To minimize the rate of oropharyngeal droplet transmission, Dr. McCannel suggested avoiding talking, coughing, and sneezing during intravitreal injection of anti-VEGF agents, and encouraging patients to refrain from talking during this time as well.

1. McCannel CA. Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: causative organisms and possible prevention strategies. Retina. 2011;31(4):654-661.